Advice please

[Blue_89]

Hi I speak to GP about these today what do I need to ask thanks

TSH 44.6 (0.2 - 4.2)

Free T4 9.2 (12 - 22)

Free T3 3.0 (3.1 - 6.8)

Ferritin 27 (30 - 400)

Iron 8.1 (6.0 - 26.0)

Transferrin saturation 16 (12 - 45)

Folate 2.3 (2.5 - 19.5)

Vitamin B12 154 (180 - 900)

Vitamin D 22.7 (<25 severe vitamin D deficiency)

Red blood count 4.43 (3.8 - 5.8)

White cell count 7.11 (4 - 11)

MCV 76.2 (80 - 98)

MCHC 377 (310 - 350)

MCH 28.2 (28 - 32)

Haemoglobin 116 (115 - 150)

Haematocrit 0.43 (0.37 - 0.47)

Platelet count 256 (140 - 700)

[Gambit62 Administrator]

you have macrocytosis. Your B12 and folate are low - meaning you are probably deficient.

Assuming you are based in UK you should be asking for loading shots.

You also need to put together your symptoms

pernicious-anaemia-society....

if you have neurological symptoms there is a more aggressive regime for loading shots and for maintenance.

no neurological involvement: loading = 3xweekly for two weeks then maintenance shots every 3 months

neurological involvement: loading = 3x weekly until symptoms stop improving (review at 3 weeks) followed by maintenance shots every 3 months

[Blue_89 in reply to Gambit62]

Thankyou I have neurological involvement

[Curlygal in reply to Gambit62]

Sorry to quibble but doesn't it look like microcytosis? Because of the iron deficiency?

[Gambit62 Administrator in reply to Curlygal]

thanks Curlygal - yes you are correct - microcytosis (eyes were obviously a bit wobbly last night) from iron deficiency

Blue_89 this means multiple vitamin and mineral deficiencies, pointing to an absorption problem - which GP should also be investigating - candidates would include PA, Crohn's, H pylori

it doesn't affect the treatment for B12 deficiency.

You may need to remind your GP that 25% of people who are B12deficient don't present with macrocytosis and neurlogical effects can and often do precede obvious haematological effects - this is even more the case if iron deficiency is also present